title: A pragmatic randomised controlled trial of 'PhysioDirect' telephone assessment and advice services for patients with musculoskeletal problems: economic evaluation.
abstract: OBJECTIVE
  To compare the cost-effectiveness of PhysioDirect with usual physiotherapy care for patients with musculoskeletal problems.
  
  
  METHODS
  (1) Cost-consequences comparing cost to the National Health Service (NHS), to patients, and the value of lost productivity with a range of outcomes. (2) Cost-utility analysis comparing cost to the NHS with Quality-Adjusted Life Years (QALYs).
  
  
  METHODS
  Four physiotherapy services in England.
  
  
  METHODS
  Adults (18+) referred by their general practitioner or self-referred for physiotherapy.
  
  
  METHODS
  PhysioDirect involved telephone assessment and advice followed by face-to-face care if needed. Usual care patients were placed on a waiting list for face-to-face care.
  
  
  METHODS
  Primary clinical outcome: physical component summary from the SF-36v2 at 6 months. Also included in the cost-consequences: Measure Yourself Medical Outcomes Profile; a Global Improvement Score; response to treatment; patient satisfaction; waiting time. Outcome for the cost-utility analysis: QALYs.
  
  
  RESULTS
  2249 patients took part (1506 PhysioDirect; 743 usual care). (1) Cost-consequences: there was no evidence of a difference between the two groups in the cost of physiotherapy, other NHS services, personal costs or value of time off work. Outcomes were also similar. (2) Cost-utility analysis based on complete cases (n=1272). Total NHS costs, including the cost of physiotherapy were higher in the PhysioDirect group by £19.30 (95% CI -£37.60 to £76.19) and there was a QALY gain of 0.007 (95% CI -0.003 to 0.016). The incremental cost-effectiveness ratio was £2889 and the net monetary benefit at λ=£20 000 was £117 (95% CI -£86 to £310).
  
  
  CONCLUSIONS
  PhysioDirect may be a cost-effective alternative to usual physiotherapy care, though only with careful management of staff time. Physiotherapists providing the service must be more fully occupied than was possible under trial conditions: consideration should be given to the scale of operation, opening times of the service and flexibility in the methods used to contact patients.
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Sandra
authors.initials: S
authors.lastname: Hollinghurst
authors.forename: Joanna
authors.initials: J
authors.lastname: Coast
authors.forename: John
authors.initials: J
authors.lastname: Busby
authors.forename: Annette
authors.initials: A
authors.lastname: Bishop
authors.forename: Nadine E
authors.initials: NE
authors.lastname: Foster
authors.forename: Angelo
authors.initials: A
authors.lastname: Franchini
authors.forename: Sean
authors.initials: S
authors.lastname: Grove
authors.forename: Jeanette
authors.initials: J
authors.lastname: Hall
authors.forename: Cherida
authors.initials: C
authors.lastname: Hopper
authors.forename: Surinder
authors.initials: S
authors.lastname: Kaur
authors.forename: Alan A
authors.initials: AA
authors.lastname: Montgomery
authors.forename: Chris
authors.initials: C
authors.lastname: Salisbury
keywords: PRIMARY CARE; costs & cost analysis; economic evaluation; physiotherapy; telehealth